- Tamara Gayle
1. Georgetown University School of Medicine’s Student National Medical Association hosted its second annual Melanin in Medicine event in February 2020, and you were a participant. Can you tell us more about this experience?
This was a wonderful opportunity for Black DC area physicians such as myself to be part of an evening discussing different issues that we often come across with the SNMA chapter at Georgetown with their medical students. There were several important issues that came up such as advocating for your Black patients when you feel like they are being discriminated against. As a medical student I remember, unfortunately, experiencing this and feeling powerless to stand up for my patient because of the power differential. We offered different strategies to try such as encouraging them to ask the team open ended questions such as, "Is this how we generally approach this”, or “why was this treatment chosen?" If there is a difference noticed, it is important to draw attention to it. The students also shared times when they themselves felt discriminated against, and we as a panel were also able to share past experiences we have unfortunately also had and strategies to address it.
2. Along the same lines, besides identifying racial stigmas and racial health care disparities, what can pediatric hospitalists do, either in their clinical work or in their role as educators and hospital administrators, to create positive change in this area?
I think there are several things that are important in this area; the first is if you see something, say something. Often we see instances of blatant discrepancies in care and do not address it in that moment whether it is behavior by nurses, our specialist colleagues, residents or other trainees, etc. It is not sometimes the blatant overtures we are expecting to see but the small and frequent microaggressions that color experiences of so many people of color. The next area I think that is important is educating ourselves on our own biases and the very painful history of the United States. If you do not have time to sit down and read, I highly recommend audiobooks, podcasts for your commute, and there's tons of streaming content. Lastly, I highly encourage having conversations with your patients and families from different backgrounds. Ask them how things are going during their hospitalizations, what has discouraged or encouraged them, and what has been difficult for their families during this time. Talk to people in your own communities that look different than yourself. We can only understand and learn from what we allow ourselves to see.
3. We read online that you and your husband had a long-distance relationship for a few years before getting to settle down together in the same city. Many couples in medicine go through similar experiences, and it can be challenging in the midst of the stressors of training and now COVID. What advice would you give to other young physicians faced with a similar situation?
Yes, Chris, my husband, and I were long distance prior to being together in DC. I think the biggest advice is to over communicate. What I mean by that is work to communicate more than you might want to or think is necessary, but it helps to connect. That means sharing the big things and the little things. I think maybe sometimes we felt like we knew too much about the other person's day down to what they had for lunch, but it helped to feel connected. It makes it easy when you try to communicate frequently that when you're trying to make a big decision or frustrated by something, they've gotten most of the puzzle pieces necessary to help you along the way! We would text, do facetime and phone calls, send each other funny memes through Instagram or Facebook, e-mail stories or articles that made us think of the other person, and whatever else. We would occasionally send each other snail mail too. The other thing that was important to me was to also always have a next visit planned, so I could always look forward to that even if it was further away than I might like because of our schedules. If it existed, I knew there was a set time and date we would be together again until it was permanent and that helped to keep me going.
4. As a co-author of “Screening for Social Determinants of Health in Hospitalized Children”, tell us what pediatric hospitalists should be asking during admission to screen for social determinants of health. What’s a big takeaway or two from your work on this important topic?
I think the biggest takeaway I've seen is that we as pediatric hospitalists are for the most part, not asking the questions at all. I think screening has been delegated to our outpatient colleagues, but it is certainly in our lane too. If we do not ask, how will we know? I think it is of course more complicated than that, as not everyone is in a situation where they have the resources to accommodate a positive screen or know when or what to ask. Currently with the COVID-19 pandemic, we are seeing record numbers of food insecurity and need, so I think the validated two question screen for food insecurity would be the best place to start. Before asking though it would be important to know what the resources are in your community. We are seeing many food banks and food pantries are struggling to keep up with the new increase in need. The questions are:
For each statement, please tell me whether the statement was often true, sometimes true, or never true for your household in the last 12 months.
1. “We worried whether our food would run out before we got money to buy more.”
2. “The food we bought just didn’t last, and we didn’t have money to get more.”
A response of “often true” or “sometimes true” to either question = positive screen for food insecurity.
5. You were a junior mentor for the New Century Scholars Program with the Academic Pediatric Association. What is this program, and how did you get involved?
I cannot recommend this program enough. The mission of the New Century Scholars Program is to increase the pipeline of underrepresented pediatricians to careers in academic medicine and takes place during the second and third years of residency. I was encouraged to apply by one of my mentors, and it was a career changing experience for me. I was connected to wonderful mentors who looked like me and were doing the work I hoped to do. It was the inspiration that I needed as I did not have the same type of encouragement and mentorship in my residency program, and I credit it to much I've been able to achieve and plan to achieve. The opportunity to be a mentor was a natural yes. There is a natural desire to want to give back to programs you feel were so pivotal for yourself. My mentee just matched into his top choice for pediatric cardiology fellowship and has great promise ahead of him, so I am very proud.
6. We would like to celebrate your brother’s legacy and impressive career that was cut short. Can you tell us about Gayle Nation and the Tyrone Gayle Scholars Program at Clemson University, and how you are remembering your brother that you lost at just 30 years old to colon cancer?
My brother was known as "the mayor" amongst his friends and that was partly how the idea of Gayle Nation started, as my brother seemed to be connected and know people everywhere. Gayle Nation is what we call those connected in supporting my brother and now charged with continuing his legacy. He was a political dynamo and I know he would be taking his seat in our incoming administration as his last job was as the press secretary for now Vice President Kamala Harris. One of the most admirable things about my brother is how committed he was to mentoring others, particularly since there are so few Black men in the political communications field. He went to Clemson for undergrad and absolutely loved it. We wanted to honor his legacy by combining two of the things he was most passionate about, providing opportunities for future Black political all-stars and Clemson. He was concerned that many students do not have the resources to take on an unpaid internship in DC (or elsewhere) over the summers during undergrad to set them up for post graduate employment. The scholarship sponsors two Clemson students to pursue political related internships each summer and pays for their living expenses. My brother Tyrone is the best of us; to know him was to love him, and it is an honor to share about him. More info can be found at www.GayleNation.com. To lose him was to lose a piece of myself. It has forever changed my life, particularly how I approach medicine and my empathy for patients and families.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
"Be kind for everyone is fighting a battle you know nothing about." I think about this quote often in terms of how difficult my brother's journey was fighting cancer, my own journey through grief, and the countless trials and tribulations I am sure harbor in the hearts and minds of our fellow colleagues, patients, and families. The pandemic has just made everything that much more difficult for many who were already struggling. What I am saying is we all just need to be a little extra gentle and extra loving with our fellow humans as we try to make it through this thing called life.
This was a wonderful opportunity for Black DC area physicians such as myself to be part of an evening discussing different issues that we often come across with the SNMA chapter at Georgetown with their medical students. There were several important issues that came up such as advocating for your Black patients when you feel like they are being discriminated against. As a medical student I remember, unfortunately, experiencing this and feeling powerless to stand up for my patient because of the power differential. We offered different strategies to try such as encouraging them to ask the team open ended questions such as, "Is this how we generally approach this”, or “why was this treatment chosen?" If there is a difference noticed, it is important to draw attention to it. The students also shared times when they themselves felt discriminated against, and we as a panel were also able to share past experiences we have unfortunately also had and strategies to address it.
2. Along the same lines, besides identifying racial stigmas and racial health care disparities, what can pediatric hospitalists do, either in their clinical work or in their role as educators and hospital administrators, to create positive change in this area?
I think there are several things that are important in this area; the first is if you see something, say something. Often we see instances of blatant discrepancies in care and do not address it in that moment whether it is behavior by nurses, our specialist colleagues, residents or other trainees, etc. It is not sometimes the blatant overtures we are expecting to see but the small and frequent microaggressions that color experiences of so many people of color. The next area I think that is important is educating ourselves on our own biases and the very painful history of the United States. If you do not have time to sit down and read, I highly recommend audiobooks, podcasts for your commute, and there's tons of streaming content. Lastly, I highly encourage having conversations with your patients and families from different backgrounds. Ask them how things are going during their hospitalizations, what has discouraged or encouraged them, and what has been difficult for their families during this time. Talk to people in your own communities that look different than yourself. We can only understand and learn from what we allow ourselves to see.
3. We read online that you and your husband had a long-distance relationship for a few years before getting to settle down together in the same city. Many couples in medicine go through similar experiences, and it can be challenging in the midst of the stressors of training and now COVID. What advice would you give to other young physicians faced with a similar situation?
Yes, Chris, my husband, and I were long distance prior to being together in DC. I think the biggest advice is to over communicate. What I mean by that is work to communicate more than you might want to or think is necessary, but it helps to connect. That means sharing the big things and the little things. I think maybe sometimes we felt like we knew too much about the other person's day down to what they had for lunch, but it helped to feel connected. It makes it easy when you try to communicate frequently that when you're trying to make a big decision or frustrated by something, they've gotten most of the puzzle pieces necessary to help you along the way! We would text, do facetime and phone calls, send each other funny memes through Instagram or Facebook, e-mail stories or articles that made us think of the other person, and whatever else. We would occasionally send each other snail mail too. The other thing that was important to me was to also always have a next visit planned, so I could always look forward to that even if it was further away than I might like because of our schedules. If it existed, I knew there was a set time and date we would be together again until it was permanent and that helped to keep me going.
4. As a co-author of “Screening for Social Determinants of Health in Hospitalized Children”, tell us what pediatric hospitalists should be asking during admission to screen for social determinants of health. What’s a big takeaway or two from your work on this important topic?
I think the biggest takeaway I've seen is that we as pediatric hospitalists are for the most part, not asking the questions at all. I think screening has been delegated to our outpatient colleagues, but it is certainly in our lane too. If we do not ask, how will we know? I think it is of course more complicated than that, as not everyone is in a situation where they have the resources to accommodate a positive screen or know when or what to ask. Currently with the COVID-19 pandemic, we are seeing record numbers of food insecurity and need, so I think the validated two question screen for food insecurity would be the best place to start. Before asking though it would be important to know what the resources are in your community. We are seeing many food banks and food pantries are struggling to keep up with the new increase in need. The questions are:
For each statement, please tell me whether the statement was often true, sometimes true, or never true for your household in the last 12 months.
1. “We worried whether our food would run out before we got money to buy more.”
2. “The food we bought just didn’t last, and we didn’t have money to get more.”
A response of “often true” or “sometimes true” to either question = positive screen for food insecurity.
5. You were a junior mentor for the New Century Scholars Program with the Academic Pediatric Association. What is this program, and how did you get involved?
I cannot recommend this program enough. The mission of the New Century Scholars Program is to increase the pipeline of underrepresented pediatricians to careers in academic medicine and takes place during the second and third years of residency. I was encouraged to apply by one of my mentors, and it was a career changing experience for me. I was connected to wonderful mentors who looked like me and were doing the work I hoped to do. It was the inspiration that I needed as I did not have the same type of encouragement and mentorship in my residency program, and I credit it to much I've been able to achieve and plan to achieve. The opportunity to be a mentor was a natural yes. There is a natural desire to want to give back to programs you feel were so pivotal for yourself. My mentee just matched into his top choice for pediatric cardiology fellowship and has great promise ahead of him, so I am very proud.
6. We would like to celebrate your brother’s legacy and impressive career that was cut short. Can you tell us about Gayle Nation and the Tyrone Gayle Scholars Program at Clemson University, and how you are remembering your brother that you lost at just 30 years old to colon cancer?
My brother was known as "the mayor" amongst his friends and that was partly how the idea of Gayle Nation started, as my brother seemed to be connected and know people everywhere. Gayle Nation is what we call those connected in supporting my brother and now charged with continuing his legacy. He was a political dynamo and I know he would be taking his seat in our incoming administration as his last job was as the press secretary for now Vice President Kamala Harris. One of the most admirable things about my brother is how committed he was to mentoring others, particularly since there are so few Black men in the political communications field. He went to Clemson for undergrad and absolutely loved it. We wanted to honor his legacy by combining two of the things he was most passionate about, providing opportunities for future Black political all-stars and Clemson. He was concerned that many students do not have the resources to take on an unpaid internship in DC (or elsewhere) over the summers during undergrad to set them up for post graduate employment. The scholarship sponsors two Clemson students to pursue political related internships each summer and pays for their living expenses. My brother Tyrone is the best of us; to know him was to love him, and it is an honor to share about him. More info can be found at www.GayleNation.com. To lose him was to lose a piece of myself. It has forever changed my life, particularly how I approach medicine and my empathy for patients and families.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
"Be kind for everyone is fighting a battle you know nothing about." I think about this quote often in terms of how difficult my brother's journey was fighting cancer, my own journey through grief, and the countless trials and tribulations I am sure harbor in the hearts and minds of our fellow colleagues, patients, and families. The pandemic has just made everything that much more difficult for many who were already struggling. What I am saying is we all just need to be a little extra gentle and extra loving with our fellow humans as we try to make it through this thing called life.